In addition to the databases like Embase (RRID: SCR_001650), PubMed (RRID: SCR_004166) and Google Scholar (RRID: SCR_008878) were searched. Two essential terms were used in the search: artificial intelligence and family planning. The other terms “family planning”, “digital technology”, “artificial intelligence”, “contraceptive use”, “future” and “strategies” were also used. •

Inclusion criteria: All articles which provides the information on AI based family planning strategies and in relation with policy implementation as an aspect of public health in India, published in the English language between 2013 and 2023, were considered for inclusion in the study.

A total of 153 articles were retrieved from PubMed, Google scholar and other websites. After discarding duplicate citations, a total of 120 records were screened according to the eligibility criteria mentioned above. 34 articles were excluded at this stage as they dealt with topics unrelated to AI in family planning, 42 were excluded because of insufficient details; records published in languages other than English; and because they were general commentaries on family planning that did not specifically discuss in related with artificial intelligence. A total of 44 records were included in the final review. The details of this process are summarized in Figure 1, and these are discussed below.

India, one of the most populous countries in the world (second only to China), has a sizable rural population and a sizable agrarian economy, according to UNDP 2017 data. According to some analysts' comparisons of the populations of China and India, India will exceed China in the next 15 to 20 years as the nation with the most labour resources and will also surpass China in terms of national competitiveness. ⁹ China, on the other hand, will lose ground in the global race due to a lack of labour resources. The economy, resources, and environment are all under a great deal of pressure from the rapidly growing Indian population. Indians, in comparison with Chinese people, have a high marriage rate, a low median age for marriage, a high birth rate, a high rate of illiteracy, a preference for having boy children, a slow rate of urbanization, and a dense population in major cities. India, the second-most populous country in the world, has 1.35 billion people. Additionally, it has the fastest-growing economy among developing nations. This population rise has attracted attention on a global and domestic level due to the significant conflicts between demographic and economic development. ¹⁰

From 450.55 million in 1960 to 1.43 billion in 2023, India's population increased. In 63 years, there has been a rise of 216.5%. India experienced the highest growth, at 2.36 percent, in 1974. The smallest growth expected to occur in 2023, at 0.61%. ¹¹ NFHS-V reports that India's total fertility rate (TFR) is 2.0 and that married women (aged 15 to 49) use contraceptives 66.7% of the time, with 56.5% of them favouring modern methods. ¹²

The following are some of the main reasons why India needs family planning: •

Population control: India is expected to surpass China as the world's most populous nation by 2027 thanks to one of the greatest rates of population increase in the world. Family planning can aid in reducing the rate of population growth and keep the nation from overpopulation. ¹³

In India, family planning is a crucial tool for advancing health, happiness, and sustainable development.

The ability of AI to quickly and accurately analyze complicated medical data with super-human precision and consistency is one of the key applications of AI in healthcare that is gaining popularity. ¹⁷ AI has already demonstrated outstanding performance in a number of fields, including cardiovascular risk prediction, ¹⁸ skin cancer screening, ¹⁹ and diabetic retinopathy diagnosis. ²⁰ Modern AI-based techniques may now operate equally effectively on portable platforms, especially smartphones, thanks to advancements in microelectronics and machine learning. Smartphones are used by more than 4.4 billion people worldwide, making them a prime option for developing point-of-care technology. ²¹ Smartphone cameras have been utilised in point-of-care tests for the qualitative and quantitative identification of clinically important biomarkers for diseases like HIV/AIDS and syphilis, ²² herpes, ²³ sickle cell disease, ²⁴ male infertility, ²⁵ and Zika. ²⁶

Many low- and middle-income (LMIC) nations are hopeful that AI will help solve problems specific to the global health sector and hasten the achievement of sustainable development goals for health. This sense of hope is driven by improvements in mobile computing power and information technology infrastructure. A number of fundamental issues, including whether AI can be ethically and scientifically justified decisions on health therapies, have been brought up in relation to AI-driven health interventions. ²⁷ AI has already started to be employed for a variety of LMIC-specific health challenges, with interventions mostly targeting infectious diseases like malaria and tuberculosis. Although there are many different kinds of AI, most employ signal processing or machine learning in some way. AI based applications are commonly combined with other methodologies, most frequently signal processing, as well as with other machine learning techniques. AI-driven health interventions can be divided into four subgroups: patient morbidity or mortality risk assessment, diagnostic, disease outbreak prediction and surveillance, and health policy and planning. However, the majority of research on AI-driven solutions for global health does not outline the ethical, legal, or useful conditions for their widespread adoption. ²⁸ Although the field is still in its early stages, AI-driven health interventions may improve health outcomes in LMICs. The global health community must move fast to establish standards for development, testing, and use as well as to create a user-driven research agenda to promote fair and ethical use. Despite the fact that some of the challenges in designing and executing these treatments may not be specific to certain locations. ²⁹

AI boosts medical practitioners' inventiveness. These intelligent machines behave like people and quickly understand the language used to record medical information, text, images, bioinformatics, and financial activities. These machines can read human language for a choice that is 100% accurate. ^{30 , 31} It enables a precise surgical treatment of the patient by providing essential information. With the use of this technology, it will be possible to find and collect enough reliable patient data to be able to predict patient outcomes, reduce risk during joint replacement surgery, shorten hospital stays, and improve recovery rates. ^{32 , 33}

An unparalleled opportunity to use digital innovations to improve voluntary family planning programmes has been generated by rising investments in new technologies throughout low- and middle-income nations. Programmes, services, and users may be significantly impacted by the application of AI to improve decision-making and get fresh perspectives on family planning. The development of AI is only just begun. Practitioners shouldn't pass up the chance to use AI to broaden the reach and increase the effectiveness of family planning programmes as these methods and tools are improved. ³⁴

Many aspects of healthcare, including family planning, could be revolutionised by AI. ³⁵ Here are some examples of how AI might assist in family planning: •

AI is now able to analyse a person's health information, lifestyle choices, and other data to suggest the most suitable and effective form of contraception for them. This might improve the efficiency of birth control methods and lower the number of unintended pregnancies. ³⁶

In general, AI has the potential to enhance family planning's use, effectiveness, and personalization. However, it's essential to ensure that AI-powered solutions are developed and used responsibly, with a focus on privacy, ethics, and equity. ⁴¹

The use of AI-driven apps for health promotion and education can help with the achievement of many sustainable development goals set forth by the United Nations. The Population Foundation of India created SnehAI, the first Hinglish (Hindi + English) AI chatbot in the nation, taking into account social and behavioural trends in India. While offering a concealed, friendly, and comfortable setting to encourage conversations about taboo subjects (including safe sex and family planning), it gives factual, practical, and reliable information and resources. SnehAI is an inventive, entertaining, and instructive solution that enables communication and education about sensitive and important topics for demographic groups that are at risk and hard to reach. It serves as a powerful illustration of the essential potential of AI technologies to advance societal good. ⁴²

For couples who choose natural family planning, the ability to precisely anticipate ovulation at home with affordable point-of-care diagnostics can be quite helpful. The two most popular at-home techniques for ovulation detection right now are keeping an eye on basal body temperature and testing urine samples for hormones that are particular to ovulation. However, the results of these procedures are unclear, and their extended usage is exceedingly expensive. AI is used in a smartphone-based point-of-care system for automatic ovulation detection to identify fern patterns in a little sample of air-dried saliva. Using samples of synthetic and actual saliva, the effectiveness of the device was evaluated, and it was found to be >99% effective in accurately predicting ovulation. ⁴³

A study has been conducted on a mobile phone-based chatbot that is intended to advise users about family planning and contraceptives. The information in Chatbot was developed using The Population Council's Balanced Counselling Strategy (BCS). The attitudinal and behavioural aspects that influence people's intentions to use chatbot have been evaluated using the Unified Theory of Acceptance and Use of Technology (UTAUT) model of technology adoption. The study comprised 49 married or living together adults (18 years and older). According to regression analysis, having a positive attitude is the main factor that predicts whether someone will use a chatbot to get information on family planning. Therefore, to ascertain a positive attitude toward using the Chatbot, effort expectancy, and performance expectancy was used. The study has implications for developing mobile messaging services that will help mothers, couples, and community health workers learn about family planning in a secretive, interesting, and engaging manner. This is the first study that, to the best of our knowledge, thoroughly evaluates the effectiveness of a Chatbot for family planning assistance that works on mobile devices. ⁴⁴

In 2020, the IT company Quilt.AI examined digital content from four social media platforms using an AI tool called Culture AI to learn more about the knowledge, attitudes, and motives of young people in the Indian states of Uttar Pradesh and Bihar regarding family planning. Based on their online behaviours linked to family planning, internet users between the ages of 16 and 24 were divided into eight categories by Quilt. AI. These categories included conformists (38%), spiritualists (21%), skeptics (15%), crusaders (9%), activists (6%), persuaders (6%), moralists (4%) and experientialists (1%). They also discovered the distinctive skews on family planning-related themes on various social media platforms. The data enables individuals involved in behavior-change communications to customize their messaging to target particular young demographics. They can affect attitudes and behaviors around family planning by providing the best platform. ⁷

Some examples of family planning applications based on AI are enlisted in Table 1.

Overall, these AI-based tools are assisting in enhancing the effectiveness, personalization, and accessibility of family planning for people all over the world.

Table 2, compares AI-based family planning techniques to more conventional ones, emphasising the benefits of AI-based methods in terms of personalization, real-time data analysis, decision support, remote access, predictive modelling, technology integration, scalability, data-driven insights, continuous learning, and cost-effectiveness. Utilising cutting-edge technologies and data analytics, it illustrates the potential advantages that AI could offer to family planning programs. ^{7 , 50 , 51}